Ong Jin Han Malcolm, Lim Bernard J W, Zahrin Muhammad Ariffin B M, Yong Isaac J S, Tan Luke L L, Mao Ren Hao Desmond, Ong Marcus E H, Siddiqui Fahad Javaid
Acute & Emergency Care Department, Khoo Teck Puat Hospital, Singapore, Singapore.
School of Science and Technology, Singapore University of Social Sciences, Singapore, Singapore.
Int J Emerg Med. 2025 Jul 8;18(1):125. doi: 10.1186/s12245-025-00933-0.
Emergency department (ED) overcrowding is a worldwide issue with significant negative consequences, including increased patient mortality. Ambulance diversion (AD) is sometimes used as an intervention to momentarily relieve overcrowded EDs, however, jury is still out about the negative consequences both for emergency medical services (EMS) who are required to divert to an alternative destination, and for patients whose care is delayed. Additionally, there is no operational guidance to best operationalize AD. The objective of this scoping review was to collate and organize the peer-reviewed published literature on the effects of both diversion and diversion aversion measures, on emergency medical services (EMS) and patient outcomes.
A systematic, comprehensive search was conducted in various databases to identify relevant studies. Medline, Embase, CINAHL, Psychinfo, Cochrane and ClinicalTrials.gov databases were searched. Online ACEP and NAEMSP portals were also searched. Included studies discussed AD in the setting of ED overcrowding that reported either EMS or patient outcomes. The effects of interventions implemented to reduce AD were also reported. Two independent reviewers screened the articles and consensus was reached when disagreements arose.
Out of 10,061 identified records, 95 papers meeting the inclusion criteria contributed to the results. 51 were observational, 16 simulation, 15 interventional, 10 descriptive, 2 systematic reviews and 1 mixed method. 12 articles reported negative EMS outcomes compared to only 2 neutral or positive EMS outcomes. 19 articles reported negative patient outcomes, whereas 9 reported neutral or positive outcomes. 34 articles reporting on intervention attempts to reduce diversion found overall positive results with diversion aversion. Only 7 articles studied the qualitative effects of diversion.
There is no conclusive evidence on the effects of AD on EMS and patient outcomes. 31 articles reported negative EMS or patient outcomes with 11 articles reporting neutral or positive outcomes. Measures to reduce or avoid diversion, however, showed overall positive trend in the results when diversion was averted. More research to ascertain accurate effects with standardised criteria for outcomes is required. Qualitative outcomes were also not well reported and further research should be conducted to determine the psychological impact on both staff and patients.
急诊科过度拥挤是一个全球性问题，会产生严重的负面后果，包括患者死亡率上升。有时会采用救护车分流（AD）作为一种干预措施，以暂时缓解过度拥挤的急诊科压力，然而，对于需要转向其他目的地的紧急医疗服务（EMS）以及护理被延误的患者所产生的负面后果，尚无定论。此外，对于如何最佳实施救护车分流，也没有操作指南。本范围综述的目的是整理和组织同行评审发表的文献，内容涉及分流及分流规避措施对紧急医疗服务（EMS）和患者结局的影响。
在多个数据库中进行了系统、全面的检索，以识别相关研究。检索了Medline、Embase、CINAHL、Psychinfo、Cochrane和ClinicalTrials.gov数据库。还检索了在线美国急诊医师学会（ACEP）和美国紧急医疗服务医师学会（NAEMSP）门户网站。纳入的研究讨论了在急诊科过度拥挤情况下的救护车分流，并报告了紧急医疗服务（EMS）或患者结局。还报告了为减少救护车分流而实施的干预措施的效果。两名独立评审员筛选文章，出现分歧时达成共识。
在10,061条识别记录中，95篇符合纳入标准的论文对结果有贡献。51篇为观察性研究，16篇为模拟研究，15篇为干预性研究，10篇为描述性研究，2篇为系统评价，1篇为混合方法研究。12篇文章报告了负面的紧急医疗服务（EMS）结局，而只有2篇报告了中性或正面的紧急医疗服务（EMS）结局。19篇文章报告了负面的患者结局，而9篇报告了中性或正面结局。34篇报告干预措施以减少分流的文章发现，总体而言，分流规避取得了积极成果。只有7篇文章研究了分流的定性影响。
关于救护车分流（AD）对紧急医疗服务（EMS）和患者结局的影响，尚无确凿证据。31篇文章报告了负面的紧急医疗服务（EMS）或患者结局，11篇文章报告了中性或正面结局。然而，当避免分流时，减少或避免分流的措施在结果中显示出总体积极趋势。需要更多研究以标准化结局标准确定准确影响。定性结局报告也不充分，应进一步开展研究以确定对工作人员和患者的心理影响。
